Up next in 10
Daughter's Urgent Concern for Father (and how Geriatric Care could have Helped)
Mar 5, 2025
Are you facing challenges in providing geriatric care for your parents? This educational video offers solutions and insights into the complexities of caring for geriatric care parents. #GeriatricCare #ElderlyCareEducation #SeniorHealthTips #CaregiverSupport #AgingParents #GeriatricCareParents #EducationalVideo
View Video Transcript
0:01
hello everybody this is Dr arish sharuk
0:03
I'm a geriatrician and oncologist with
0:05
more than 12 years of experience of
0:08
taking care of older adults with or
0:09
without cancer my area of expertise and
0:13
interest is improving outcomes and Care
0:15
process for older adults regardless of
0:19
whether they have cancer or not one step
0:22
in achieving that is to empower and
0:25
inform patients and caregivers
0:27
especially when it comes to aging
0:28
related issues
0:30
so with that the title of this talk is
0:33
what you should know about geriatric
0:35
care and why it
0:37
matters so in this lecture we are going
0:40
to understand what Frailty is we are
0:42
going to become more familiar with
0:44
Frailty assessments and we are going to
0:47
appreciate the benefits that
0:48
collaboration between geriatricians and
0:50
other disciplines bring for older
0:53
patients and their
0:55
caregivers so let's start with a case
0:58
this case is very familiar to many of
1:00
you regardless of the diagnosis or any
1:03
other characteristic of this case this
1:05
is the Curious Case of Mr P so Mr P is a
1:08
82y old male who was admitted to the
1:10
hospital with shortness of bread this
1:12
was his third hospital visit with the
1:15
same complaint in just two months
1:18
diagnostic workup shows that his chess
1:20
cray is showing some fluid in the long
1:23
Echo confirms weaken heart with ejection
1:26
fraction of just 30% the normal is more
1:29
than 50 50
1:31
55% and the medical team correctly
1:33
diagnosed this patient with acute heart
1:35
failure basically heart notot pumping
1:38
the blood as much as it should causing
1:40
some back flow fluid in the lungs and in
1:43
the legs so the treatment that the
1:45
medical team has planned for was to
1:47
administer fide which is a medication to
1:50
increase urination and not surprisingly
1:53
Mr P experienced a symptomatic
1:55
Improvement within 24 hours of that
1:58
treatment
2:01
however the next day the medical team
2:03
receives a frantic call from a concerned
2:05
daughter the daughter mentions that my
2:07
father has fallen multiple times in the
2:09
past few months it may not be safe for
2:11
him to go home my father is probably not
2:14
taking his medications properly as I
2:16
have found his medication bottles
2:18
beneath the couch my father's appetite
2:21
has also been poor and he has lost some
2:23
weight you may not have noticed it
2:25
because he was very swollen I'm also
2:27
very worried about his cognition at
2:29
times I feel he's not as sharp as he was
2:32
before this story is very similar to
2:36
many stories that we hear and we
2:39
encounter for our older parents older
2:41
grandparents older family members when
2:44
they are in the hospital and the the
2:47
medical team focuses on the main
2:49
presenting symptom and the main
2:51
diagnosis but the question is what the
2:54
medical team should have done and what
2:55
was
2:58
missing so the question for you would be
3:03
what do you see in this page I will give
3:05
you five seconds to think about
3:11
it so I'm sure a lot of you have
3:15
mentioned that what you're seeing is
3:17
either a circle or a DOT and that is
3:20
true that Circle or a DOT is heart
3:22
failure this patient main diagnosis was
3:25
heart failure but was there anything
3:28
else that we needed to see let's take a
3:30
look a little bit deeper and you see
3:33
some smaller dots that in the first sort
3:36
of assessment was not visible to many
3:38
care providers so what are these smaller
3:42
dots these smaller dots are diseases and
3:46
issues like dementia poly Pharmacy
3:49
taking too many medications poor
3:51
nutrition exhausted caregiver many
3:54
hospitalization gate and balance
3:56
impairments and
3:57
Falls so the
4:00
medical team may say well this patient
4:02
presented resurance of breath and he was
4:04
diagnosed with heart failure we properly
4:06
treated heart failure why we should be
4:09
bothered by the rest of these issues
4:12
well the challenge is that the rest of
4:13
these issues whether we like it or not
4:16
are somehow either impacting the main
4:19
diagnosis or impacting the outcome of
4:22
that main diagnosis or they are
4:24
contributing to some of the issues in
4:26
the future so for example if a patient
4:29
is is taking too many medication meaning
4:31
that the patient is experiencing bully
4:33
Pharmacy and now because of the heart
4:35
failure this patient is going to be
4:37
taking couple more medications the risk
4:39
of non-compliance in this patient is
4:41
quite high and this patient may not take
4:43
his medications properly and may come
4:45
back to the hospital or if the patient
4:48
takes his medications properly but has
4:50
been suffering from gate and balance
4:52
impairment because of lightheadedness
4:53
and dizziness because of the drop in the
4:56
blood pressure this patient may fall and
4:58
experience a hip fracture and need
5:00
another hospitalization and surgery or
5:04
if the caregiver is already exhausted
5:06
there's no way that that caregiver can
5:08
provide hard healthy meal for these
5:10
patients you know the low sodium diet
5:12
that many cardiologists and heart
5:15
doctors advis for these sort of
5:18
patients but even if we see these
5:21
smaller dots we still may have Miss the
5:24
white page or the white Slide the white
5:27
background so what is that white page or
5:30
white
5:31
background that is the whole patient
5:34
that is Mr
5:36
P throughout this whole process we have
5:39
missed Mr P as a whole we focus on some
5:43
diseases We Shrunk Mr P to bunch of
5:47
diseases and issues without respecting
5:50
him as a whole you know what matters to
5:53
him what is his background what sort of
5:57
goals he's trying to achieve what are
5:59
the challenges that he's experiencing
6:01
etc
6:03
etc and in most extreme cases this gets
6:06
into the theory of shatter window so the
6:08
theory of shatter window describes a
6:10
situation where Specialists Focus only
6:13
on their area of expertise creating a
6:16
fracture approach that fails to address
6:18
the whole person need so imagine a
6:20
patient with multiple severe illnesses
6:23
like enderage renal disease on dialysis
6:27
moderate to severe cognitive impairment
6:30
severe heart failure and is now
6:32
diagnosed with cancer and the medical
6:35
oncologist might be embarking on
6:37
administering chemotherapy to this
6:40
patient this patient may have had no
6:42
functional activity and have been
6:44
dependent on others for almost all of
6:48
his daily activities and at the same
6:50
time he may have experienced some
6:52
exhausted support system because of
6:55
increasing needs that he has had
7:00
so this I call it ever growing
7:02
multi-dimensional problem of the Aging
7:04
population so this is not just Mr P by
7:08
2050 the number of people age 65 and
7:12
older is projected to become more than
7:14
double reaching 1.6 billion globally in
7:18
the United States adults over 65 will
7:21
represent nearly 22% of the population
7:24
by 2040 this demographic shift increases
7:28
demands for chronic disease management
7:30
and specialized geriatric care while
7:33
creating Workforce shortages in
7:34
geriatric medicine also these patients
7:37
because of advances in other disciplines
7:40
which is a great news however that leads
7:42
to long-term care needs such as more
7:45
medical attention and long-term care
7:47
facilities Etc and on the social and
7:51
economic side that creates some
7:53
Financial strain on the system and calls
7:56
for the need for age-friendly Community
7:58
planning and housing options this leads
8:01
us to what I call it the new age
8:03
Challenge and that is not all older
8:05
adults are at the same level of Fitness
8:07
the Aging population represents a
8:09
diverse spectrum of physical and
8:11
cognitive capabilities that cannot be
8:14
approached with one- siiz fital approach
8:16
this diversity requires a personal
8:18
approach to geriatric care recognizing
8:21
that chronological age often poorly
8:23
predicts an individual functional
8:25
abilities health status or care
8:27
needs I'm pretty sure have seen two 80y
8:31
olds who have had different level of
8:33
Fitness one is a marathon runner the
8:36
other one is unfortunately is not doing
8:38
very well and at times it's not just
8:40
about two 80 year olds one 80y old and
8:44
the other one is 75y old might have a
8:46
different level of Fitness that
8:48
80-year-old might be more fit than the
8:50
75y old and so on these people also may
8:55
experience different level of cognitive
8:57
function one might be very robust and
8:59
sharp while the other unfortunately may
9:01
have experienced some cognitive decline
9:04
even in the earlier and younger ages and
9:07
also these patients might differ in
9:09
terms of their medical complexity one
9:11
patient may experience one or two
9:14
comorbidities such as high blood
9:16
pressure or high cholesterol but then
9:18
the other one may experience 10 12
9:21
comorbidities and some of them very
9:23
severe like dialysis severe cognitive
9:26
impairment multiple Falls hip fracture
9:29
and so on so the new AG challenge
9:32
pressures Healthcare Providers to
9:34
develop individualized assessment tools
9:36
and treatment plans that address the
9:38
specific needs preference and
9:40
capabilities and capacities of each
9:42
older
9:43
adult this becomes somewhat more
9:46
problematic when patients are admitted
9:48
to the hospital and that is most of the
9:50
time medical assessment for older
9:52
patients begin with a generic phrases
9:55
like 82-year-old male without describing
9:58
the whole person
10:00
healthare rate records reduce older
10:02
adults to age gender and chief complaint
10:05
failing to capture their overall health
10:07
status functional capacity and personal
10:09
preferences as we discussed two 82y old
10:13
men might have completely different
10:15
capabilities one living independently
10:17
and being physically active and the
10:19
other one being frail with some
10:21
cognitive decline requiring significant
10:23
assistance this reduction approach
10:26
especially during Hospital stay leads to
10:28
inappropriate care plans and missed
10:30
intervention
10:33
opportunities so many of us are
10:37
interested in predicting outcomes from a
10:40
patient and caregiver point of view that
10:42
usually comes with questions like what
10:44
are my
10:45
prognosis what is my ability to go back
10:48
home and remain independent I don't want
10:51
to be a burden on my family what is the
10:54
likelihood of that thing happening
10:56
Etc and in reality a negative outcome is
10:59
a product of Frailty and stressors so we
11:03
are going to talk a lot more about
11:04
Frailty but a stressors could be reason
11:07
for admission and its severity
11:09
procedures tests and treatments that you
11:11
are scheduled to go for comorbidities
11:14
and their severity that you're
11:16
experiencing and other environmental
11:18
stressors such as availability of the
11:21
caregiver availability to accessing
11:23
various resources in the community the
11:26
financial strain that you may be
11:28
experiencing and so on
11:30
so when frail is combined with multiple
11:32
stressors the risk of adverse clinical
11:34
outcomes increases
11:37
proportionally so what can substitute
11:39
age I'm pretty sure many of you have
11:42
wondered why this doctor is treating me
11:45
or not treating me simply based on my
11:47
age or why that doctor gave me that
11:49
treatment I couldn't tolerate it why he
11:52
gave it to me despite my older age in
11:55
reality in geriatrics we are not very
11:57
interested in age of the patient but we
11:59
are interested on whether you're frail
12:02
or fit so what is frailty Frailty is
12:05
your body's decreased or complete
12:07
inability to tolerate a stress which
12:10
represent a state of increased
12:11
vulnerability to adverse outcomes when
12:13
exposed to a stressors so let's talk
12:16
about this more so these are three
12:18
patients one is managing well or
12:20
considered to be fit and the other one
12:22
has mild Frailty and the other one has
12:23
severe Frailty let's say these three
12:26
patients are all age 82 two and they are
12:30
all going for resection of the part of
12:32
their large intestine because they are
12:34
diagnosed with colon cancer the one that
12:37
is managing well or also known as fit
12:40
that per person under goes that surgery
12:43
stays in the hospital for a few days uh
12:45
recovers very quickly goes home and
12:47
probably is not going to be readmitted
12:49
to the hospital at all on the other hand
12:52
a patient with severe falty who under
12:54
goes the same surgery may stay in the
12:56
hospital for weeks may end up with some
12:58
complication PA s may experience a
13:01
significant functional Decline and may
13:03
never recover to the Baseline that he
13:05
was so this is what Frailty
13:10
means many Studies have shown the
13:13
relationship between Frailty and outcome
13:15
so this is a study on close to 67,000
13:19
patients who underwent cardiac surgery
13:22
and as you see frail patients were two
13:24
times more likely to have mortality
13:26
during the time of surgery and three
13:28
time times more likely to have midterm
13:31
mortality they were at much higher risk
13:33
for prolonged Hospital stay and be
13:36
discharged to non-home settings such as
13:38
nursing home or rehab
13:41
facilities there's also a difference uh
13:44
in life trajectory of Fit versus frail
13:47
patients so fit older adults typically
13:49
maintain their functional Independence
13:51
for much longer period of time with a
13:53
shorter period of disability before that
13:55
and relatively steep terminal Decline
13:58
and the other hand frail older adults
14:00
often experience earlier functional
14:02
decline with prolonged periods of
14:04
disability more frequent hospitalization
14:07
and gradual downward
14:09
trajectory these distinct paths directly
14:12
impact quality of life and response to
14:14
Medical interventions highlighting why
14:17
personalized assessment Beyond
14:18
chronological age is
14:22
essential it's also important to note
14:25
that the relationship between Frailty
14:26
and health outcomes is a two-way streak
14:29
Frailty can lead to negative clinical
14:32
outcomes however negative clinical
14:34
outcome can also worsen Frailty creating
14:37
in the most extreme cases a vicious
14:39
cycle for example if a patient who is
14:42
frail is admitted to the hospital
14:44
because of that prolong Hospital stay
14:46
and bed rest during that hospital stay
14:48
may lose more muscle mass and be at risk
14:50
for additional Frailty fs and fractures
14:53
which can then worsen Frailty breaking
14:56
the cycle requires proactive Frailty
14:59
assessment targeted preventive
15:01
interventions and Specialized Care
15:03
approaches that addresses the unique
15:05
vulnerabilities of all frail older
15:09
adults it's also important to note the
15:12
relationship between Frailty and age
15:15
although as we age we are more likely to
15:18
experience Frailty but not all older
15:20
patients are frail as we discussed there
15:23
could be two 85 year olds one could be
15:26
very fit and the other one could be very
15:28
frail also not older adults or not
15:31
people of the same age are going to be
15:34
frail one study showed that only 25% of
15:37
adults over the age of 85 is considered
15:39
to be frail while 75% of them maintain
15:42
varying degree of
15:44
robustness again understanding this
15:46
complex relationship enables Healthcare
15:49
Providers to move Beyond age-based
15:51
assumptions and develop more
15:53
personalized care
15:56
approaches so the golden standard of a
15:58
assessing Frailty is comprehensive
16:00
geriatric assessment a multi-dimensional
16:02
interdisciplinary diagnostic process to
16:05
determine an older person's medical
16:07
psychological and functional
16:09
capabilities components of geriatric
16:12
assessment include evaluation of
16:13
physical health cognitive function
16:15
psychological State functional abilities
16:18
like activities of daily living like
16:20
bathing and grooming instrumental
16:22
activities of daily living taking
16:24
medications handling finances
16:26
availability of social support
16:28
Environmental factors and nutritional
16:30
status this assessment provides a more
16:33
accurate prediction of outcomes than
16:35
chronological age alone helping
16:38
clinicians develop personalized care
16:39
plans that address a specific
16:41
vulnerabilities and
16:43
strengths this is conducted by
16:45
interdisciplinary team which includes
16:47
geriatricians nurses social workers
16:49
physical therapists pharmacist and other
16:51
Specialists as needed when implemented
16:54
systematically geriatric assessment has
16:56
been shown to reduce Hospital
16:57
readmissions decrease Healthcare cost
17:00
improve quality care and quality of life
17:04
and help maintain functional
17:05
Independence in all
17:09
adults there are various initiatives to
17:12
incorporate geriatric assessment and
17:13
management in different phases of care
17:16
we do have geriatric emergency
17:18
department these are specialized
17:19
emergency departments designed to meet
17:21
the unique needs of older adults
17:24
featuring enhanc staff training modify
17:27
physical environments and integrate ated
17:29
geriatric assessment protocols to
17:31
improve outcomes and reduce Hospital
17:34
admissions geriatric surgery
17:36
verification program which developed by
17:38
American College of Surgeons to
17:39
systematically improve surgical care for
17:41
older adults we do have geriatric
17:44
impatient units as well as outpatient
17:47
geriatric clinics which are dedicated to
17:49
provide comprehensive evaluation and
17:51
Care planning to support Community
17:53
dwelling order adults serving as a
17:55
coordination hubs for complex care needs
17:58
and preventive
18:00
interventions so in conclusion geriatric
18:03
care requires moving beyond
18:05
chronological age to truly understand
18:08
and address the complex needs of order
18:09
adults and throughout this presentation
18:12
we explored how traditional approaches
18:14
to Elderly Care often fall short as
18:16
illustrated by the case of Mr P we've
18:19
seen how chronological age alone is
18:22
inadequate predictor of Health outcomes
18:24
and clinical needs instead comprehensive
18:27
geriatric assessment and Frailty
18:28
measurement provide a more accurate
18:31
picture of an older adult's condition
18:34
the key takeaways from this
18:36
presentation include fry not age is a
18:41
better predictor of clinical outcomes
18:42
and should guide treatment decisions the
18:45
shattered window Theory highlights how
18:47
seemingly minor issues can Cascade into
18:49
major Health crisis for older adults and
18:53
unfortunately even at that time some
18:54
care providers still may miss the crisis
18:58
comprehensive Peri atric assessment
18:59
involving interdisciplinary team
19:01
significantly improve patient outcomes
19:04
and Specialized Care models such as
19:06
emergency department surgical programs
19:08
impatient and outpatient clinics and
19:10
units have demonstrated Effectiveness in
19:12
reducing complications and improving
19:14
quality of life the multi-dimensional
19:17
challenges of an aging population
19:19
require Innovative approaches that
19:21
address physical cognitive and social
19:23
aspects of Care by implementing these
19:26
evidence-based approaches across
19:27
Healthcare settings
19:29
we can transform care for older adults
19:31
improving their quality of life reduce
19:33
health care costs and better address the
19:37
complex needs of all our aging
19:39
population if you like this presentation
19:43
please like the video subscribe to the
19:46
channel and share it with your family
19:49
members and friends again this is Armen
19:52
Shuki I'm a geriatric oncologist very
19:55
dedicated to improving care for older
19:57
adults with or without can answer and I
19:59
hope you enjoy this lecture
#Aging & Geriatrics